Warts Flashcards
What are the clinical feature of verruca vulgaris?
hyperkeratotic, exophytic, dome-shaped papule or nodule
koebnerize
What is the most common location of verruca vulgaris?
fingers, dorsal hands, knees, elbows
What do the black dotes mean in verruca vulgaris?
thrombosed capillaries
What is koebnerize?
look up
What causes verruca vulgaris?
HPV 2, 4
What is the pathology of HPV wartz?
hyperplasia of epithelium
What does HPV infect?
basal keratinocytes of cutaneous and mucosal epithelium
How is HPV transmitted?
skin to skin or contaminated objects, wart to unaffected skin
What causes verrucae plana - flat warts?
HPV 3, 10
What causes palmoplantar warts?
HPV 1
What causes condylomata acuminata - external genital warts?
HPV 6, 11, 16, 18, 31
When is peak prevalence of warts?
13-16 yo adolescence, can also be younger and older
What percentage of warts resolve in 2 years?
75% but not realistic
How do you treat warts?
multiple tx, laser, acids, cryotherapy
What is the only FDA approved treatment for genital warts?
imiquimod
What are primarily irritating or destructive txs for warts?
cryotherapy, salicyclic acid, tretinoin cream, shave removal, adhesive tape, laser
What is the primarily immune stimulating tx for warts?
imiquimod, candida antigen (IL), immunotherapy (squaric acid or DCNB)
When do you use the candida antigen?
when other things fail
What are the side effects of cryotherapy?
PIPA (postinflammatory pigment alteration), scar, pain, blister, nail dystrophy
What are the clinical features of external genital warts?
not hard or hyperkeratotic, sessile papules, may be papules or large confluent plaque
Where are genital warts present?
external genitalia, perineum, perianal, inguinal fold
How do you do cryotherapy?
white ring 2-3 mm outside bump 2x
Who has the highest incidence of EGW?
20-34 yo
What are risk factors for EGW?
sex at early age, numerous partners, unprotected exposure
What is used for prevention of EGW?
HPV vaccine
What type of HPV infection does immunosuppressed pt get?
frequent, persistent, difficult to treat
higher risk of anal squamous cell carcinoma
Which of the following tx would you use for genetial warts?
cryotherapy, immiquimod, pdophyllin
What are the surgical tx for EGW?
laster, electrocautery, scissor, shave
How does verrucae planae present?
skin colored or pink, smooth surfaced slightly elevated
Where does verrucae planae occur?
dorsal hands, arms, face (exposed surfaces)
How does palmoplantar verruca present?
thick, endophytic (depressed into skin of soles) papules, mosaic warts –> large plaques –> thick callus over and around wart,
Are plantar warts painful?
yes when walking
What treatments do you start with?
ones that minimize side effects and risk of scarring
If you have few warts on your hand or foot, how do you treat?
salicyclic acid, adhesive tape, cryotherapy, laser
If you have few warts on face, how do you treat?
cryotherapy, shave (surgical) removal
If you have few warts at other sites, how do you treat?
cryotherapy and salicyclic acid
If you have many hand and foot warts, how do you treat>
salicyclic acid, cryotherapy, squaric acid or DCNB laser
If you have many face warts, how do you treat?
cryotherapy, tretinoin cream
If you have many warts at other sites, how do you treat?
imiquimod, tretinoin cream, squaric acid or DCNB
What is the mechanism of salicyclic acid?
keratolytic loosens connections btw keratinocytes, infected with HPV
What improves cure rate?
combo salicyclic acid and cryotherapy
What are the adverse effects of salicyclic acid?
erythema, peeling, irritation, maceration (due to occlusion)
Approximately what proportion of pt are wart free at 2 years w/o treatment?
60%
How do you do cryo?
two freeze cycles for 30 seconds or more, remove any thick overlying callus is removed
Smooth, dome shaped papules with central umbilication in genital area
molluscum contagiosum
papillomatous, exophytic papules and plaques in genital area
external genital warts
What are the surgical treatment for EGW?
laser, electrocautery, scissor or shave debulking
Who is gardasil FDA approved for?
M and F 9-29 yo
What vaccine is quadrivalent?
gardasil
What vaccine is bivalent against 16 and 18?
ceravix
Who is ceravix approved for?
females 10-25 (NO MALES)
